EDUARDO HIROSHI AKAISHI
Projetos de Pesquisa
Unidades Organizacionais
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject 0.75mm Breslow Index as Standard Cut-off in Sentinel Lymph Node Biopsy for Melanoma(2012) MOUTINHO, V.; AKAISHI, E.; UTIYAMA, E.; MENDES, G.; TEIXEIRA, F.; FERREIRA, F.; PERINA, A.; RASSLAN, S.Introduction: Breslow index is the most important risk factor for melanoma progression. Breslow index cutoff to perform sentinel node biopsy is not consensual among institutions worldwide. Our study aims to discuss if 0.75mm is an adequate cut-off for sentinel node biopsy for melanoma. Methods: Retro- spective charts from initial 115 patient files from May/2008 to June/2011 were analyzed. Sentinel lymph node biopsy was routinely carried out in patients with Breslow >0.75mm and in high risk patients with Breslow < or =0.75mm (pres-ence of ulceration, regression, mitoses and Clark levels IV/V). Two groups were defined based on Breslow: (A) < or =1.00mm - major group with 17 patients; (B) 0.76-1.00mm - subgroup of 5 patients at threshold for sentinel biopsy. Both groups were compared with Breslow > 1.00 patients as Control Group, using Fischer’s test. High risk of recurrence characteristics were reviewed in patients with Breslow <0.76mm and expressed as percentages. Results: Sen- tinel lymph node biopsies were positive in 40,5% (15/37) of melanomas with Breslow >1.00mm. In patients with Breslow < or =1.00mm (A) there was 5.8% (1/17) sentinel node positivity. In the subgroup of patients with Breslow 0.76- 1.00mm (B) sentinel nodes were positive in 20% (1/5). When testing statisti- cally, Group A (< or =1.00mm) was different from Control group patients (> 1.00mm) regarding sentinel node positivity (p=0.008), while Group B (0.75- 1.00 mm) was similar to Control group patients (p=0.35). In patients with Bres- low <0.76 mm with high risk characteristics on pathologic report, ulceration was not present in any patient, 16,7% were Clark levels IV/V, mitoses were present in 70% of patients, lesions were in vertical phase of growth in 40% and regression was present in 36%. Conclusions: 1. Sentinel node biopsy in melanomas with Breslow 0.76-1.00mm should be routinely indicated due to a high positivity rate (20% in our sample) in this range. 2. Node positivity in patients with Breslow <0.76mm (5.8%) was statistically different from node positivity in Breslow >1.00mm group (40%; p=0.008) rising the question that indication of sentinel node biopsy in Breslow <0.76mm is controversial.